Study Purpose:

To evaluate the effectiveness of a group rehabilitation intervention in improving cognitive function in cancer survivors

To explore the phenomenon of cognitive impairment and the relationship between objective and subjective measurements of cognition

Intervention Characteristics/Basic Study Process:

The intervention, based on self-regulatory cognitive rehabilitation and cognitive behavioral principles, consisted of four weekly two-hour group sessions with between-session homework. Each session consisted of psycho-education, group discussion, and reinforcement of the content by skill development and application. Subject matter included overall information on cognition with specific information on memory, attention, and the impact of fatigue and emotions on cognition. Application exercises focused on goal setting, problem solving, relaxation, compensatory and enhancement strategies, and cognitive-behavioral strategies related to emotional adjustment, fatigue, sleep, and self-care.

All participants receiving the intervention were assessed at baseline, post-treatment (six weeks after the baseline assessment), and follow-up (three months after the second assessment). Study participants not receiving the intervention were assessed at similar time frames but only for the first two time periods.

Sample Characteristics:

A total of 53 patients participated in the study. Their ages ranged from 34–84 years with a mean age of 58.3 years.

The sample was 40% male and 60% female.

Breast, colorectal, and prostate cancers accounted for 84.5% of the sample; the remaining 15.5% included ovarian, testicular, neck, and mixed cancers.

All patients had undergone treatment with surgery, radiation, and/or chemotherapy and completed treatment a minimum of four months prior. Patients' education level ranged from 9–25 years with a mean level of 15.2 years.

Results:

In contrast to the cancer and community comparison groups, the intervention group had a significant improvement in immediate memory (p < 0.01), visuospatial skill (p < 0.001), language (p < 0.001), attention/concentration (p < 0.05), delayed memory (p < 0.001), and total cognitive score (p < 0.001) over the six-week time interval as measured by the RBANS. No change was found in either information processing speed as measured by the TMT-A or executive function as measured by the TMT-B.

The intervention group was re-evaluated three months later; improvements remained, or were sustained, in immediate memory (p < 0.001), visuospatial skill (p < 0.001), delayed memory (p < 0.001), and total cognitive score (p < 0.001), but not in language or attention/concentration. At the final assessment, a significant improvement was also found on the TMT-A (p < 0.01). Although no change was found in self-report of cognitive function as measured by the MASQ, a significant improvement was found over time as measured by the FACT-Cog (p < 0.05).

Conclusions:

Significant improvement was found in several cognitive domains for patients who received the group intervention. Many of these improvements were sustained three months after the completion of the intervention. The results of the subjective measures of cognitive function were mixed. This study found that a short group intervention may improve cognitive ability for cancer survivors over a limited period of time.

Limitations:

The study was at risk for bias because no control group, random assignment, or appropiate attentional control condition existed.

The intervention was expensive and impractical and required special training needs.

Nursing Implications:

Further research is indicated, with larger sample sizes and longer follow-up, to determine whether group cognitive rehabilitation might be warranted to treat cognitive impairments. More detailed information regarding the intervention is needed to determine whether it could be facilitated by nurses rather than the clinical psychologists in the study.